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Ulcerative Colitis

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Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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Abstract

Pediatric ulcerative colitis is a relatively common chronic illness of childhood, affecting approximately 25,000–50,000 children in the USA. The precise cause of ulcerative colitis remains unknown, but is believed to result from an interplay of genetic, environmental, and immunologic factors. Genes that may alter the risk of ulcerative colitis development include IL-23R, IL-26, and IL-10. Environmental factors that increase risk may include antibiotic exposure in early life and vitamin D deficiency. Diagnosis is established by colonoscopy with biopsy. Upper endoscopy and small-bowel imaging are also important to assist in differentiating ulcerative colitis from Crohn’s disease. Induction therapy of ulcerative colitis includes mesalamine (for milder cases), corticosteroids (for moderate disease), and antitumor necrosis factor antibodies and calcineurin inhibitors for steroid unresponsive disease. Maintenance therapy includes aminosalicylates, thiopurines, or antitumor necrosis factor antibodies. In severe or medically refractory cases, surgery (colectomy) should be considered.

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Abbreviations

6MP:

6-mercaptopurine

6-TUA:

6-thiouric acid

6-MMP:

6-methyl mercaptopurine

6-TGN:

6-thioguanine nucleotide

25(OH)D:

25-hydroxy vitamin D

AGA:

American Gastroenterological Association

ALT:

Alanine aminotransferase

Anti-TNF-α:

Anti-tumor necrosis factor-alpha

ASA:

Aminosalicylate

ASCA:

Anti-Saccharomyces cerevisiae

ASA:

Aminosalicylate

AZA:

Azathioprine

CBir1:

Flagellin

CD:

Crohn’s disease

CI:

Confidence interval

CRC:

Colorectal cancer

CRP:

C-reactive protein

CT:

Computed tomography

EN:

Erythema nodosum

ESPGHAN:

European Society for Pediatric Gastroenterology Hepatology and Nutrition

ESR:

Erythrocyte sedimentation rate

GWA:

Genome-wide association

HLA:

Human leukocyte antigen

HR:

Hazard ratio

HLA:

Human leukocyte antigen

IBD:

Inflammatory bowel disease

I2:

Pseudomonas fluorescens-associated sequence

IL:

Interleukin

IPAA:

Ileal pouch-anal canal anastomosis

MAdCAM-1:

Mucosal addressin-cell adhesion molecule-1

MCV:

Mean corpuscular volume

MRI:

Magnetic resonance imaging

MTX:

Methotrexate

NF-kappaB:

Nuclear transcription factor kappa B

NSAIDs:

Non-steroidal anti-inflammatory drugs

OCP:

Oral contraceptive

p-ANCA:

Perinuclear antineutrophil cytoplasmic antibodies

PG:

Pyoderma gangrenosum

PSC:

Primary sclerosing cholangitis

PUFAs:

Polyunsaturated fatty acids

PUCAI:

Pediatric ulcerative colitis activity index

VTE:

Venous thromboembolism

UC:

Ulcerative colitis

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Authors and Affiliations

  1. GI Division—Inflammatory Bowel Disease Center, Children’s Hospital, GI Hunnewell Ground, 300 Longwood Avenue, 02115, Boston, MA, USA

    Leslie M Higuchi, Brian P Regan & Athos Bousvaros

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  1. Leslie M Higuchi
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  2. Brian P Regan
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  3. Athos Bousvaros
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Correspondence to Leslie M Higuchi .

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Editors and Affiliations

  1. Department of Pediatrics, University of Chicago, Chicago, Illinois, USA

    Stefano Guandalini

  2. Clinical Director Child Health King’s College Hospital, Professor and Director Pediatric Liver, GI and Nutrition Center, London, United Kingdom

    Anil Dhawan

  3. Department of Pediatrics, Hebrew University Hadassah Hospital, Jerusalem, Israel

    David Branski

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Higuchi, L., Regan, B., Bousvaros, A. (2016). Ulcerative Colitis. In: Guandalini, S., Dhawan, A., Branski, D. (eds) Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-319-17169-2_30

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